Chapter 07 My Nursing Test Banks

Tabloski Gerontological Nursing, 3/e
Chapter 07

Question 1

Type: MCSA

During an interview, the nurse notes that an older patient is having mild difficulty with some words and forgets the names of people. The patient is alert, oriented to time, person, and place, and makes appropriate responses. What does the nurse determine this patients cognitive changes to mean?

1. Normal signs of aging

2. Early symptoms of dementia

3. Indicators of depression in the elderly

4. Memory impairment that may be related to cerebral ischemia

Correct Answer: 1

Rationale 1: Cognitive changes vary widely in the elderly; however, older people will not suffer significant memory impairment. Many may experience mild problems with word finding and remembering names. The changes observed in this patient are normal signs of aging.
Reference: Page 164

Rationale 2: A problem with finding words and forgetting names is not a symptom of dementia.
Reference: Page 164

Rationale 3: A problem with finding words and forgetting names is not a symptom of depression.
Reference: Page 164

Rationale 4: A problem with finding words and forgetting names is not related to cerebral ischemia.
Reference: Page 164

An older patient wakes up from sleep, confused, and insists a family member is in the other room. What information within the patients medical record should the nurse consider as a source of the patients confusion?

1. The patient is elderly.

2. The patients spouse recently died.

3. The patient received pain medication.

4. The patient has a history of cardiac disease.

Correct Answer: 3

Rationale 1: Age does not cause confusion.
Reference: Page 166

Rationale 2: The loss of a loved one may cause depression but is not identified as a reason for confusion.
Reference: Page 166

The nurse is providing discharge instructions to an older patient that includes the administration of insulin. Which strategy will the nurse use when instructing this patient to adjust to the normal changes experienced with aging?

1. Giving written materials to compensate for short-term memory losses

2. Using tools that repeat the information until the information is understood

3. Considering holding sessions for longer periods than usual so the patient can learn

4. Providing instruction to relatives so that the patient will not need to learn everything

Rationale 2: There is no information to suggest that sleep problems and insomnia are predictive signs of respiratory disease.
Reference: Page 169

Rationale 3: Symptoms that indicate an older person may be suffering negative effects of stress include sleep problems and insomnia.
Reference: Page 169

Rationale 4: There is no information to suggest that sleep problems and insomnia are expected manifestations of cardiac disease.
Reference: Page 169

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Basic Care and Comfort

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Explain the impact of age-related changes on stress and coping.

Question 7

Type: MCMA

An older African American patient is diagnosed with a mental health problem that has been untreated for many years. What does the nurse realize as reasons for this patients problem not being adequately treated?

Rationale 5: Respecting medical personnel is not identified as being a factor that contributes to poor mental health in minority elders. Most minority elders mistrust medical personnel which can contribute to poor mental health in this population.
Reference: Page 167

An older patient being treated for abdominal pain reports no relief of pain and other somatic complaints after receiving adequate pain medication. What additional intervention is indicated for this patient?

1. Reviewing the patients lab values

2. Contacting the family to talk to the patient

3. Further assessment and treatment for depression

4. Obtaining an order for different pain medication

Correct Answer: 3

Rationale 1: The laboratory values are of no significance in this patient situation.
Reference: Page 172

Rationale 2: The family may be ineffective in meeting the patients psychological needs.
Reference: Page 172

Rationale 3: The major signs of depression in the older person include multiple somatic complaints and reports of persistent chronic pain.
Reference: Page 172

An older patient tells the nurse that alcohol is used occasionally to combat stress. The patient is a recent widow, retired, and admits to feeling worthless at times. The nurse realizes this patient is at risk for which health problem?

1. Suicide

2. Paranoia

3. Dementia

4. Liver failure

Correct Answer: 1

Rationale 1: Older persons over the age of 65 have the highest suicide rates of all age groups. A major risk factor for suicide is depression. An inappropriate feeling of worthlessness is a symptom of depression.
Reference: Page 175

Rationale 2: The patient is not demonstrating symptoms of paranoia.
Reference: Page 175

Rationale 3: The patient is not demonstrating symptoms of dementia.
Reference: Page 175

Rationale 4: Occasional use of alcohol does not necessarily indicate that the patient is at risk for liver failure.
Reference: Page 175

The son of an older patient is concerned about the patients ongoing forgetfulness and asks the nurse to explain what could be wrong with the patient. How should the nurse respond to the son?

1. Memory difficulties are hard for family members to deal with.

2. My parents are the same age as yours, and they cant remember anything.

3. Forgetfulness is common in older adults. Its nothing you need to worry about.

4. Memory difficulties can be due to underlying issues including anxiety, chronic pain, or depression.

Correct Answer: 4

Rationale 1: Memory difficulties are difficult for family members to deal with, but this is not the most appropriate statement at this time. The nurse is discounting the sons feelings.
Reference: Page 170

Rationale 2: The nurse is showing sympathy with the statement about the parents but is not addressing the sons feelings.
Reference: Page 170

Rationale 3: Forgetfulness is common in older adults, but this statement is not therapeutic.
Reference: Page 170

An older patients spouse passed away 4 years ago; however, the patient still sets a place at the dinner table for the spouse and has never removed any clothing or other personal items from the home. What does the nurse suspect the patient is experiencing?

1. Normal grief

2. Hopelessness

3. Survivor guilt

4. Pathological grief

Correct Answer: 4

Rationale 1: Normal grief is that which lasts within a 2-year time frame.
Reference: Page 171

Rationale 2: Hopelessness is when the patient sees no hope in life. This is not what the patient is experiencing.
Reference: Page 171

Rationale 3: Survivor guilt is associated with a traumatic event where a person survives when another loved one does not.
Reference: Page 171

Rationale 4: Grief persisting longer than 2 years is considered pathological in the United States.
Reference: Page 171

During an assessment, the nurse learns that an older patient experiences much stress and feels the heart racing at times. The nurse explains that this is the fight-or-flight response and is associated with which body chemical?

The nurse caring for older patients in a long-term care facility is organizing a depression screening program for the residents. How will this screening program benefit the older patients?

1. Differentiates dysthymia from delirium

2. Supports care expectations of the older patients family members

3. Depression symptoms are often associated with chronic illness and pain.

4. Depression is the easiest mood disorder to detect and treat in older patients.

Correct Answer: 3

Rationale 1: Screening an older patient for depression is not done to differentiate dysthymia from delirium. Older patients may experience persistent feelings of sadness but not meet the criteria for depression.
Reference: Page 172

Rationale 2: Screening older patients for depression is not done to support care expectations of older patients family members. This action helps to identify those patients who need intervention to treat depression.
Reference: Page 172

Rationale 3: Depression is the mental health problem of greatest frequency and magnitude in the older population. The risk of depression in the older person increases with other illnesses and when ability to function becomes limited. Symptoms of depression are often associated with chronic illness and pain.
Reference: Page 172

Rationale 4: Depression in older adults is often undetected and untreated. Primary healthcare providers are often not vigilant or consistent in their diagnosis of depression and may fail to make the diagnosis.
Reference: Page 172

The nurse is planning an educational session on suicide in the older patient population. What information should the nurse include in this presentation?

Standard Text: Select all that apply.

1. Suicide rates are the highest in teens.

2. A patient should never be questioned about suicide intent.

3. Suicide rates are the highest in people age 65 and older.

4. An older person who contemplates suicide is more likely to complete the act than a younger person.

5. Approximately 70% of older adults who commit suicide had visited their primary care physician within the previous month.

Correct Answer: 3,4,5

Rationale 1: Older persons age 65 and over have the highest suicide rates of all age groups.
Reference: Page 175

Rationale 2: Suicide intent is part of the nursing assessment for depression.
Reference: Page 175

Rationale 3: Older persons age 65 and over have the highest suicide rates of all age groups.
Reference: Page 175

Rationale 4: An older person who contemplates suicide is more likely to complete the act than a younger person because older people often employ lethal methods when attempting suicide, experience greater social isolation, and generally have poorer recuperative capacity, which makes them less likely to recover from a suicide attempt.
Reference: Page 175

Rationale 5: Approximately 70% of older adults who commit suicide had visited their primary care physician within the previous month.
Reference: Page 175

An older patient is prescribed a monoamine oxidase inhibitor (MAOI) medication. Which meal choice indicates that the patient needs further education regarding this medication?

1. Pepperoni pizza and diet soda

2. Baked chicken, green beans, and cherry pie

3. Fried chicken, creamed corn, and French fries

4. Chicken salad on a croissant, carrot sticks, and fresh fruit

Correct Answer: 1

Rationale 1: Because these drugs inhibit the metabolism of norepinephrine, hypertensive crisis can occur if they are administered with other drugs or food that raise blood pressure such as anticholinergics, stimulants, and foods containing tyramine including red wine, cheese, beer, bologna, pepperoni, liver, raisins, and bananas.
Reference: Page 184

Rationale 2: None of these food items contain tyramine, which should be avoided in the patient receiving a MAOI.
Reference: Page 184

Rationale 3: None of these food items contain tyramine, which should be avoided in the patient receiving a MAOI.
Reference: Page 184

Rationale 4: None of these food items contain tyramine, which should be avoided in the patient receiving a MAOI.
Reference: Page 184

The nurse is planning care for an older patient diagnosed with major depression who states that voices are telling the patient to kill himself. Which nursing diagnosis would be a priority for this patient?

1. Social isolation

2. Risk for suicide

3. Disturbed sleep pattern

4. Altered sensory perception

Correct Answer: 2

Rationale 1: Social isolation might be causing the patient to hear voices; however, this would not be the priority diagnosis at this time.
Reference: Page 184

Rationale 2: The patient is hearing voices that are telling him to kill himself. This patient is at risk for suicide.
Reference: Page 184

Rationale 3: The patient may or may not have disturbed sleep. This is not the priority diagnosis for the patient at this time.
Reference: Page 184

Rationale 4: Even though the patient is hearing voices, which would be an alteration in sensory perception, the voices are telling the patient to kill himself. This is not the priority diagnosis for the patient at this time.
Reference: Page 184